Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For patients with high risk prostate cancer, is there data to support increased morbidity, such as increased urethral strictures or cystitis, when given postprostatectomy XRT as opposed to definitive XRT?
This is a very relevant question that commonly comes up in practice - should a man with high risk prostate cancer have a prostatectomy, when the chance of him needing post-op RT is reasonably high, if he could have RT/ADT only and possibly avoid the risks associated with surgery? The discussion must...
How do you treat women who have breast-conserving surgery with positive sentinel node/s and no axillary dissection?
Three separate points to make: 1. Z-11 is often misquoted. The Z-11 trial did not randomize patients to plus or minus nodal radiation. That question was asked in the MA 20 study. In the MA 20 study, as well as a few other studies, the addition of regional radiation provides a meaningful impact on ou...
Do you order a post-lumpectomy mammogram before starting RT?
I get a new baseline mammogram prior to RT in patients who had calcifications associated with their cancer on their initial mammo. This enables me to be sure that all of the suspicious calcs have been removed. I will get this new mammo even if the path shows a neg margin, as pathology is an inexact ...
Should I avoid prescribing lidocaine-containing magic mouthwash to head and neck cancer patients?
The debate on whether to use lidocaine containing "magic mouthwash" was partially fueled by a confusing set of recommendations from the American Academy of Nursing's Choosing Wisely list of 20 things nurses and patients should question. Many radiation and medical oncologists routinely use MMW with v...
Is SVC syndrome a medical emergency?
It is usually not an emergency but rather a medical urgency and all effort should be made to get a tissue diagnosis before treatment. The goal of treatment could be curative or palliative based on the histology, stage of disease, and performance status of patient
In light of the 2 negative bevacizumab trials for up-front GBM, how do you feel about the future of bevacizumab in GBM?
At the 2010 ASTRO meeting, Dr Inder Verma of the Salk Institute gave a very nice keynote address talking about his work using a mouse model of GBM where the GBM cells themselves can morph into vessels as needed, with no expectation of response to anti-VEGF therapy. The work was published a while bac...
How many PTVs and what doses do you utilize for a cT3N0M0 squamous cell carcinoma of the larynx receiving definitive concurrent chemoradiation?
I typically think of 2 targets - a clinical target and a subclinical target. Whether one wants to divide the subclinical target into 2 targets - an intermediate and lower risk target is an option, but whether it is an absolute is a matter for debate. Traditional treatment was large fields followed b...
Should a formal radiology year(s) be added to the radiation oncology residency training program given the number and increasing modalities used for target delineation and treatment planning?
As I close in on the end of my career, I must disagree with this idea! I’m sure we all are greatly impressed by the clinical acumen of our fourth-year medical students but that is not enough clinical training. My three-year medical residency taught me how to be a DOCTOR, my radiation oncology reside...
Do you require a biopsy prior to SBRT for pulmonary metastases from oligometastatic disease?
A biopsy of a lung mass can be central to the appropriate management of your case. Some of the risk factors for GI cancers and lung cancers are the same, ie smoking. We have had several patients with anal cancers who have subsequently been found to have synchronous lung cancers with different histol...
How were decisions made about what dose constraints to use in the recent RTOG protocols for lung SBRT?
This is a question that is frequently and appropriately asked by SBRT beginners and experienced practitioners. The history of SBRT in that regard replicates much of the historic experience in RT which is that the data generated from treating the patients generated the constraints, so to speak, as op...